Chronic bronchitis is a clinically diagnosed condition.

What kind of person is considered to have chronic bronchitis? The classic patient is like this: 60 years old man, long years of smoking, in the past few years began to feel the cough increased, cough sputum also increased, cough every day, cough, cough sputum, and cough in the morning when you wake up seems to be more a little bit more cough, spring, winter cough more, especially the change of the day, the cold air down, the cough is even more powerful, this year, cough more, seems to be a little bit of wheezing, usually do not wheeze, walk fast! I don't usually wheeze, but I do when I walk fast.

The diagnosis of this disease can be considered after the above symptoms have lasted for more than 2 years and the symptoms of cough and phlegm have been present for at least 3 months each year. But there are two prerequisites.

First, do a lung function test to see if there is persistent airflow limitation, if there is, then it is considered to have developed into chronic obstructive pulmonary disease, not just chronic bronchitis. If not, then it is still just chronic bronchitis.

Second: Rule out other diseases. For example, tuberculosis, interstitial pneumonia, etc., these diseases can have similar symptoms, but they are not considered chronic bronchitis. Before diagnosing chronic bronchitis, rule out these diseases for which we already know the cause.

In summary, the diagnosis of chronic bronchitis is a clinical diagnosis.

How do you treat it?

1, quit smoking: this does not need to be explained. If you don't quit smoking, you can't treat it.

2. Exercise.

3. Use some expectorant and cough medicine.

4. Pay attention to keeping warm in winter.

5, remember to do a lung function test to rule out chronic obstructive pulmonary disease. If you already have lentigo, treatment should be more aggressive.

Generally speaking, patients will not die of chronic bronchitis because the disease is not too serious. However, if chronic bronchitis is not properly treated and smoking is not stopped, and if it is allowed to develop, it may progress to stages such as chronic obstructive pulmonary disease and pulmonary heart disease, and then it will be much more troublesome.

Definition Chronic bronchitis is a chronic nonspecific inflammation of the mucous membranes of the trachea and bronchi and their surrounding tissues. Clinically, it is characterized by coughing and sputum, which lasts for 3 months per year for 2 or more consecutive years.

Etiology and pathogenesis

The cause of the disease is not fully understood and may be the result of a combination of factors.

1. Harmful gases and particles

Such as cigarettes, smoke, dust, and irritating gases. These physical and chemical factors can damage the airway epithelial cells, leading to a decrease in airway purification function. And stimulate the submucosal receptors, parasympathetic hyperfunction, so that the tracheal smooth muscle contraction, hypersecretion of glands, airway resistance increased.

2. Infectious factors

Infections such as viruses, mycoplasmas, and bacteria are one of the most important reasons for the development of chronic bronchitis. Infectious factors cause damage and chronic inflammation of the airway mucosa. Viral infections are most common with influenza virus, rhinovirus, adenovirus and respiratory syncytial virus. Bacteria are often secondary to viral infections, and common pathogens are Streptococcus pneumoniae, Haemophilus influenzae, Catamoras, and Staphylococcus.

3. Other

Immunity, age and climate are all associated with chronic bronchitis.

clinical manifestation

symptoms　The main clinical manifestations of chronic bronchitis are cough, sputum. Shortness of breath and recurrent respiratory infections.

　　(1) Cough long-term, repeated, gradually aggravated cough is the prominent manifestation of this disease. Lightweight only in the winter and spring seasons, especially in the early morning before and after getting up the most obvious, the daytime cough is less. In summer and fall, the cough is reduced or disappears. Severe patients are coughing in all seasons, winter and spring exacerbation, day and night cough, morning and evening is particularly intense.

　　(2) Coughing sputum Generally, sputum is white mucus foamy, more in the morning, often due to viscous and not easy to spit out. After infection or cold, the symptoms rapidly intensify, sputum volume increases, viscosity increases, or yellow purulent sputum or accompanied by wheezing. Occasionally, there is blood in the sputum due to severe coughing.

　　(3) Asthma When combined with respiratory tract infection, asthma (wheezing) symptoms can be produced due to congestion and edema of the mucosa of the fine bronchial tubes, sputum obstruction and narrowing of the bronchial lumen. A wheezing sound occurs in the patient's throat during breathing, and a rumbling sound is present on lung auscultation. This type of bronchitis, which is characterized by wheezing, is clinically referred to as wheezing bronchitis; however, its exacerbations do not resemble those of typical bronchialbronchitis。

　　(4) Repeated infections Repeated respiratory tract infections are easy to occur during the cold season or when the temperature changes suddenly. At this time, the patient's shortness of breath worsens, sputum volume increases significantly and is purulent, accompanied by generalized fatigue, chills, fever, and so on. There are wet sounds in the lungs and an increase in the white blood cell count. Repeated respiratory infections are particularly likely to worsen the condition of elderly patients and must be given due attention.

　　There are no special signs in the early stage of the disease, and a few wet or dry glottal sounds can be heard at the base of the lungs in most patients. Sometimes they may disappear temporarily after coughing or sputum. When wheezing chronic bronchitis attacks, extensive rales can be heard, "wheezing relief and then disappear. Signs of emphysema may be found in cases of prolonged attacks.

　　There are three stages according to the progression of the disease.

　　(1) Acute exacerbation: refers to the appearance of purulent or mucous sputum within one week, with a marked increase in sputum volume, or with the presence ofunable think calmlyInflammatory symptoms, such as cough, phlegm, wheezing, or any of the symptoms of cough, phlegm, wheezing, etc., have increased significantly.

　　(2) Chronic prolonged delay: refers to different degrees of "cough", "phlegm", "wheezing" symptoms delayed for more than a month.

　　(3) Clinical remission: After treatment or clinical remission, the symptoms basically disappear or occasionally have a slight cough with a small amount of sputum, which remains for more than 2 months.

Laboratory tests

(1) X-ray: no abnormality in the early stage. After repeated episodes, it may show thickening and disorganization of lung texture, with lattice or striated or speckled shadows, which is obvious in both lower lungs.

(2) Respiratory function test: no abnormality in early stage. Small airway obstruction may occur as the disease progresses, and the maximum respiratory flow rate-volume curve is significantly reduced at 75% and 50% lung capacity.

(3) Blood tests: Occasionally, an increase in the total number of white blood cells and/or neutrophils may be seen in bacterial infections.

(4) Sputum examination: the causative organisms may be cultured during acute attacks.

diagnostic

1. Clinically, cough and sputum are the main symptoms, or accompanied by wheezing, and the onset of illness lasts 3 months per year for 2 or more years. (Patients with clinical symptoms of cough, sputum and wheezing for 2 or more years, but with an annual onset of less than 3 months, can also be diagnosed if there is a clear objective basis, such as X-rays and lung function).

2. Exclude other diseases with symptoms of coughing, coughing and wheezing.

A diagnosis of chronic bronchitis can be made when 2 of the above criteria are met [2].

Typing and Staging

typing

(1) Simple type: meets the diagnostic criteria of chronic bronchitis, with two symptoms of cough and sputum.

(2) Wheezing type: meets the diagnostic criteria for chronic bronchitis, with wheezing symptoms and frequent or repeated rales.

Care:

1. Actively control the infection: in the acute stage, follow the doctor's instructions and choose effective antibacterial drug treatment. After the control of acute infection, stop using antibacterial drugs in time to avoid side effects caused by long-term application.

　2. Keep the environment clean and comfortable, reduce adverse environmental stimuli, especially avoid the stimulation of dust and smoke. Maintain the appropriate temperature (18-20 °) and humidity (50-60%), in order to give full play to the respiratory defense function, pay attention to keep warm, avoid cold.

4... Promote phlegm expectoration: patients in the acute stage of the use of antibacterial drugs at the same time, the application of cough suppressants, expectorant drugs. For old and weak patients who are unable to cough up sputum or patients with more sputum, should be mainly expectorant, should not use strong cough suppressants, so as not to inhibit the central nervous system to aggravate the inflammation of the respiratory tract, resulting in the deterioration of the condition. Sputum thick and sticky should not be coughed up, the available nebulizer inhaler, adding drugs can be Qingda, chymotrypsin, etc., nebulization should pay attention to the amount of fog moderate, the amount of nebulized liquid should not be more, the general time of nebulization to 10-20 minutes is appropriate. For patients who are conscious and can cough, instruct the patient to take a deep breath and cough effectively, cough up sputum, and often change the position, which is conducive to the discharge of sputum. Chest wounds should be instructed to gently press or hold the wound site, can also be used to press a pillow on the wound, coughing pressure to offset or resist cough-induced wound localization of the pull and pain, reduce pain.

For critically ill patients, changing the position regularly and gently massaging the patient's chest and back can promote the discharge of phlegm. Longer bedridden patients, often should turn over, percussion back, because these activities caused by the change of position and lung vibration, are conducive to blood circulation and fluid circulation, more conducive to the discharge of sputum. Attention should be paid to percussion:(1). Make a brief explanation to the patient to obtain the patient's understanding and cooperation, pay attention to observe the patient's reaction during the operation, for hemoptysis, cardiovascular condition is unstable, pneumothorax, rib fracture patients, forbidden to do percussion and vibration. (2). Each percussion time is 15-20 minutes. Arrange to do it before meal and finish it 30 minutes before meal. (3). Hollow palms should be used for percussion, and an empty and deep tapping sound indicates a correct technique. (4). Percussion should avoid the breast and heart, do not carry out in the bone protruding parts, such as the sternum, scapula and spine. (5) The strength of percussion should be moderate, so that the patient does not feel pain.

5... Smoking cessation: chronic bronchitis patients should not only quit smoking first, but also avoid passive smoking, because the chemical substances in the cigarette, such as tar, nicotine, cyanohydrogen cyanide, etc., can act on the vegetative nerves, causing bronchial spasms, thus increasing the resistance of the respiratory tract; in addition, it can also damage the epithelial cells of the bronchial mucosa and its cilia, so that the bronchial mucosal secretions increase, reduce the purification function of the lungs, and easy to cause the propagation of pathogenic bacteria in the lungs and bronchi, resulting in the occurrence of chronic bronchitis. This will easily cause the propagation of pathogenic bacteria in the lungs and bronchial tubes, resulting in the occurrence of chronic bronchitis.

6. In climate change and cold season, pay attention to timely add or subtract clothes, avoid cold and flu, and prevent influenza. Observe changes in your condition.

7. Strengthen physical exercise, enhance physical fitness, improve the resistance of the respiratory tract, strengthen physical exercise to improve their physical fitness, to be able to choose medical treatment according to their physical fitnesshealth careExercise, taijiquan, five birds play and other projects, adhere to exercise, can improve the body's ability to resist disease, the amount of activity without obvious shortness of breath, rapid heartbeat and excessive fatigue to the degree. Chronic bronchitis patients in remission should make appropriate physical exercise, in order to improve the body's immune ability and heart, lung storage capacity. Preventing upper respiratory tract infections and avoiding inhalation of harmful substances and allergens can prevent or reduce the occurrence of this disease.

7., appropriate supplementation of water, daily guarantee of drinking water in more than 1500ML, enough water can make the respiratory mucosal lesions repair and mucosal wetting, enhance the activity of the cilia, prevent secretion drying, and is conducive to sputum discharge. Give the patient a high-calorie, high-protein, high-vitamin diet, should not be greasy spicy and other stimulating foods.

8. Publicize to the patient that slow branch is a long-term process, to establish confidence in treatment, active cooperation, adhere to the treatment.

The trachea is the passageway that people use when exchanging gases with nature and is an integral part of the respiratory system that should be cared for.

The location of the trachea in the human body is shown below.

Oxygen is communicated to the outside world through the smallest unit of lung tissue, which operates to exhale. See figure below.

If the trachea is blocked by inflammation, narrowing, or foreign bodies, there will be a lack of respiration, resulting in obstruction, at this time, the physiological regulation of the airway, there is a coughing action response, which makes a sound, and with the coughing spit out phlegm-like secretions, such a reaction is called bronchiectasis. Of course, there are other manifestations.

Chinese medicine's understanding of the lungs is basically similar to that of modern medicine. Just look at the following figure.

Lung is the master of qi, respiration and fur. It likes to propagate and purge, and is good at clearing the air. All the dirty gas can not offend the lungs, so we must strictly prevent the offense.

Lungs towards the hundred veins, the main absorption of the essence of the sun and moon, for the whole body of all tissues and organs of the essence of nourishment, it can be seen, trachea problems, is the lung function is blocked, the reaction, the body will regulate the various ministries, the full strength of the fight against this reaction, but also because of this, so, the slightest damage may cause coughing, wheezing, spitting, gas, and so on the emergency response, until the recovery of the. Chronic bronchitis is caused by old injuries, so it is time to strengthen the healing process. For your information.

Chronic bronchitis, or chronic bronchitis for short, is a chronic non-specific inflammation of the mucous membranes of the trachea and bronchi and their surrounding tissues caused by infectious or non-infectious factors.

The disease occurs in relation to chronic irritation, such as that associated with smoking, harmful dust, smoke (biofuels), and atmospheric pollution.

In addition, viruses and bacteria, or allergens and climate change can cause patients to develop.

Mostly closely associated with chronic irritation from infectious or non-infectious factors.

Clinical manifestations are cough, sputum or wheezing.

Annual onset lasting three months. Two or more consecutive years.

The main treatments are anti-infective, bronchodilator, asthma, and phlegm expectorant.

Patients with recurrent respiratory infections can be treated with immunomodulators and Chinese herbal medicine.

It's "slow branch";

The lesion is in the "lungs";

Symptoms are coughing, coughing up sputum, or with wheezing;

Most flare-ups occur in winter and resolve with the warmth of spring; advanced symptoms may persist year-round regardless of the season;

Complications may include emphysema, bronchiectasis, and pulmonary heart disease;

Self-diagnosis: The diagnosis of "chronic bronchitis" can be made if the onset of symptoms lasts for 3 months each year for 2 or more consecutive years and if other chronic airway diseases are excluded.

The bronchial tubes, which are the tubes through which air passes in and out of the lungs, are called bronchiectasis when there is inflammation, and with bronchiectasis the patient produces mucus (sputum). In chronic bronchitis, the cough can last up to 3 months, or up to 2 years or more. Chronic bronchitis is one of the 2 main types of Chronic Obstructive Pulmonary Disease (COPD), the other main type of COPD being "emphysema".

Why do people get the disease chronic bronchitis? The most common cause of this disease is smoking, which can cause permanent damage to the lungs. People can also develop chronic bronchitis by inhaling toxic fumes or gases.

Symptoms of chronic bronchitis include the following:

1. Coughing on most days of a period of at least 3 months, and this continues for 2 years;

2. coughing up or spitting out clear or white mucus;

3. Feeling very tired;

4. Feeling short of breath;

5. Chest discomfort or tightness.

How is chronic bronchitis treated if you have it?

1. Lifestyle modifications:. If you smoke, you should quit. Quitting smoking is one of the most critical aspects of relieving chronic bronchitis symptoms. It doesn't matter how long you have been smoking or how much you smoke. Quitting will slow down the progression of the disease and help you get relief.

2. Get the flu vaccine every fall, and you should get at least 1 dose of pneumonia vaccine. Infections like the flu and pneumonia can damage the lungs. Therefore, it is important to try to avoid these infections.

3. A wide range of prescription medications are available to treat chronic bronchitis. Most patients will use inhalers that help open the airways or reduce airway swelling. When symptoms are worse than usual, patients need to take prednisone as directed by their doctor or pharmacist.

4. If the condition worsens, some patients need oxygen.

5. Do pulmonary function rehabilitation training: In the process of pulmonary function rehabilitation, patients should learn some breathing exercise methods that help to relieve symptoms.

Na Cun, Clinical Pharmacy Office, Affiliated Hospital of Chifeng College, Member of the Pharmacy Network

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Chronic bronchitis is a recurrent cough and sputum that lasts for three months a year for more than two consecutive years.

If chronic bronchitis is not better controlled, it can cause further damage to lung function, which in severe cases can lead to the emergence of chronic obstructive pulmonary disease.

Therefore, when a clinical diagnosis of chronic bronchitis is made, the condition needs to be evaluated and judged.

Especially for patients in the stable stage, targeted treatment should be given, such as prevention of colds and vaccinations, to reduce the damage caused by acute recurrent episodes on lung function.

Note: Having been dealing with respiratory patients for 20 years or so and having been exposed to a wide variety of respiratory patients, I know your pain.

If you are suffering from respiratory disease, you can send me a private message about your condition, symptoms, etc., and I will definitely reply promptly after seeing it. (You can also attach the case or examination report.) Your health is my greatest happiness.

Chronic bronchitis is an overproduction of mucus from the bronchial glands caused by chronic inflammation of the bronchial tubes. The result is a chronic or recurring condition accompanied by sputum expectoration and coughing.

Chronic or recurrent is defined as almost daily cough and sputum, at least 3 months per year for more than 2 years, and focal bronchopulmonary disease must be excluded. For the onset of the disease age (over 40 years). Gender (men), smoking, air pollution, etc. have a great influence. According to statistics, the incidence rate of over 40 years old is 2.6% in non-infected areas and 8.9% in polluted areas, and it can even be called a national disease in our country.

Early symptoms are mild, mostly attacked in winter and relieved after spring warming; late inflammation worsens, and the symptoms exist year-round, regardless of the season. Disease progression can be complicated by obstructive emphysema and pulmonary heart disease, seriously affecting labor and health.

general nursing

Dietary and personal care

Keep the indoor air circulating and fresh to avoid harmful dust, smoke and harmful gas inhalation.There should be heating equipment in winter to avoid patients getting cold and flu to aggravate the condition. Give high protein, high calorie, high vitamin, easy to digest food on diet. The food should not be too salty, avoid fried, easy to produce gas food, such as lean meat, eggs, milk, fish, vegetables and fruits. In addition, you should drink a small amount of water several times a day, not less than 1500ml, in order to dilute the phlegm and facilitate the discharge. Autumn nature, all biological metabolism is relatively slow, people should also follow the nature of early bed and early rise, to maintain peace of mind.

Stop smoking and limit alcohol consumption

Cigarettes can lead to decreased airway immunity, and the longer you smoke and the more you smoke, the higher the prevalence.Tobacco and alcohol can damage the bronchial epithelium and easily irritate the respiratory tract leading to coughing, which is unfavorable to the treatment and prognosis of chronic bronchitis in the elderly.

Observation and care of symptoms

Cough, sputum

The nature of the cough, the time and rhythm of its appearance should be carefully observed; the nature, color, odor, and amount of sputum should be observed, and a sputum specimen should be properly retained for laboratory testing.Encourage the patient to cough effectively, cough sputum, sputum is not easy to discharge, the use of ultrasonic nebulization inhalation when possible, unconditional, according to the doctor's orders to take sputum medication, in order to dilute the sputum, easy to cough out. At the same time can also take positional drainage and other measures to discharge sputum.

Observation and care of drug therapy

The most important thing in this kind of disease is to control the infection, should be in accordance with the doctor's orders for the category of pathogenic bacteria and drug sensitivity of the rational application of antibiotics, closely observe the patient's temperature and condition changes, patiently listen to the patient's complaints.Along with medication, attention should be paid to nutritional support and to sputum thinning and drainage, which are necessary to relieve airway obstruction and effectively control infection.

Respiratory Muscle Exercise

Respiratory muscle exercise can make the respiratory muscles, especially the diaphragm strong and powerful, improve respiratory efficiency, promote phlegm discharge, can mobilize the vitality of the whole body's immune system, reduce the bronchial tube, the lungs recurrent infections and inflammation of acute episodes.Patients can perform controlled deep breathing exercises, abdominal breathing exercises, and lip-contracting exhalations during the day.

health education

Helping patients to strengthen the body's cold tolerance exercise, pay attention to the increase or decrease of clothing when the climate changes, and avoid getting cold.Cold exercise needs to start in the summer, the first hand massage face, after using cold water soaked towel wringing after rubbing the head and face, gradually and limbs. Physical fitness, strong tolerance, the whole body can be a large area of cold water friction, continued to September, and then continue to use cold water friction face and neck, at least in winter, also need to use cold water to wash the nose, in order to improve the ability to withstand the cold, to prevent and reduce the onset of the disease.

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Cough, sputum, shortness of breath with wheezing and prolonged recurrent episodes are common features of chronic bronchitis. It is mostly caused byDiseases caused by congestion and edema of the bronchial mucosa of the trachea, bronchial tubes and their surrounding tissues, and accumulation of secretions in the lumen of the tubes。

Patients with chronic bronchitisPatients wake up in the morning and cough significantly at night before bedtimeIn general, the early patients cough sound clear and powerful, mostly for a single cough or intermittent cough, with the progress of the disease cough sound turned low and powerful, and more for the continuous cough, paroxysmal emergence.

Coughing up sputum is more frequent in the early morningThe sputum is usually white mucus or clear foamy, and when combined with infection, it may become yellow pus sputum with increased sputum volume. However, when coughing more vigorously, it can lead to rupture of bronchial mucosal blood vessels, causingHemoptysis or blood in sputum。

Shortness of breath and wheezingIn the early stages of the disease, the symptoms are usually not obvious, but when the disease progresses to combined obstructive emphysema, shortness of breath and wheezing of varying degrees of severity will gradually appear, so that daily activities will be restricted later on. In addition, symptoms such as chills, fever and fatigue may also occur.

Some patients think that chronic bronchitis is not a serious disease. In fact, if you don't take the right medicine to treat the disease and let it develop, it will gradually develop into chronic obstructive pulmonary disease, pulmonary heart disease, emphysema and other diseases, not only suffer from pain, but also greatly increase the difficulty of treatment.

chronic bronchitis: Chronic bronchitis was defined as chronic coughing for 3 months per year for 2 consecutive years, and other etiologies of chronic cough (e.g., bronchiectasis) were excluded.

Chronic bronchitis may precede or follow airflow limitation. Although there is some arbitrariness in the specification of symptom duration as described above, this definition has been used in many studies. Even in the absence of airflow obstruction, smokers may develop symptoms of chronic bronchitis as early as 36 years of age, and these symptoms are associated with a higher incidence of exacerbations. Concentrations of airway mucus were elevated in current and former smokers compared with never-smokers (MUC5AC and MUC5B), and mucus concentrations were also elevated in symptomatic patients compared with patients with similar GOLD staging (Table 1) but without chronic bronchitis symptoms.

Interrelationships between asthma, chronic bronchitis, and emphysema.

Early definitions of COPD distinguished between different types (i.e., chronic bronchitis, emphysema, and asthma), and the current definition does not incorporate this distinction. However, individual patients can present with a range of COPD manifestations and associated disease course, so understanding the subtypes of COPD can help in its diagnosis.Key points on the interrelationship of the different subtypes of COPD include:

● Asthmatics with fully reversible airflow obstruction do not have COPD;

● Patients with asthma who do not have complete relief of airflow obstruction have COPD. the etiology and pathogenesis of this group of COPD patients may be different from those of patients with chronic bronchitis or emphysema;

● Chronic bronchitis with airflow obstruction and emphysema often occur together. Some of these patients may also have asthma;

● Chronic cough in asthmatics may occur spontaneously or may be caused by exposure to harmful substances (e.g., cigarette smoke, allergens). These patients are often referred to as patients with wheezing bronchopneumonia, but this term has not been formally recognized in clinical practice guidelines;

Patients with chronic bronchitis and/or emphysema are not considered to have COPD unless there is airflow obstruction;

● Airflow obstruction is not COPD if it has a known etiology or a specific pathology (e.g., cystic fibrosis, bronchiectasis, occlusive bronchiectasis); however, these exclusionary diagnoses are more loosely defined.